AggiornAmenti in riAnimAzione e terApiA intensivA - Pacini Editore

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microcirculation in cardiogenic shock:
from scientific bystander to therapy target
C. Jung
A. Lauten
M. Ferrari
First Department of Internal
Medicine, (Cardiology,
Angiology, Pneumology,
Intensive Care Medicine),
Friedrich Schiller University,
Jena, Germany
Despite diagnostic and therapeutic improvements, mortality rates in
patients with cardiogenic shock remain relatively high. Several studies
showed that cardiogenic shock is associated with alterations in the microvascular
circulation. These alterations may be reversed by extracorporeal
support devices. A study by Munsterman and colleagues adds to the body
of evidence showing that in patients deemed ready for discontinuing
intra-aortic balloon pump (IABP) support, microcirculatory flow in small
vessels increases after ceasing IABP therapy. This study not only highlights
the need for optimal timing of weaning from IABP support but also supports
recent findings that global hemodynamics do not necessarily result
in changes of microvascular perfusion. All modalities of modern treatment
in cardiogenic shock need to be evaluated for their effect on the microcirculation.
Microcirculatory evaluations should be part of randomized
controlled trial protocols. More effort is needed to improve outcomes and
understand the microcirculation as a therapy target and not as a silent
bystander.
Crit Care 2010;14(5):193